Thursday, 14 May 2009

Q & A: Screening for MRSA carriage in day case attenders for intravenous iron

Q: Donal, you've addressed this issue in your blog, but that hasn't solved the problem. Our team are now being required to do MRSA screening swabs in ALL day case attenders who will stay for more than an hour. This is based on the CfH definition of a day case, as opposed to an outpatient attendance. This means that patients undergoing endoscopy don't need screening (because it takes less than an hour) but patients requiring iv iron dextran (currently cheaper than iv Ferrinject) do require screening - which often involves an extra visit to healthcare settings solely to get the swab performed, plus extra work to collate the results and, occasionally, to act on them. This seems to be to be nonsensical. This was discussed in our infection control meeting on Friday, but similar conversations must be going on up and down the land. As you know I am a strong supporter of the Cleaner Hospitals programme and an admirer of the successes (which we have seen here) of active performance management and 'raising the bar' relating to MRSA infections; and as part of the many conversations I've had with colleagues in other disciplines, have learnt that the most powerful way to get clinicians disaffected is to impose illogical interventions! Dr Charlie Tomson, Consultant Renal Physician, Chair, UK Renal Registry

A: Charlie I am in total sympathy with the point you have raised . I discussed this with Professor Brian Duerden, CBE (Inspector of Microbiology and Infection Control, Department of Health) who told me that these patients were clearly not what we had in mind under the term "admission". Brian advised using the Operational Guidance “get-out clause “. To quote Brian directly “this is a sub-set of patients who should be excluded and this should be agreed with the local PCT and the SHA “. I would also advise that the responsible Specialist commissioners should be involved in those agreements and that the rationale is made clear to patients.